Tonsillectomy: Post-Operative Hemorrhage Reduction Strategy in Jos, North Central Nigeria.

BACKGROUND: Post-tonsillectomy hemorrhage (PTH) is one of the more life-threatening /lethal complications and the leading malpractice claims/convictions in Oto-laryngological practice. OBJECTIVE: A Study on PTH reduction strategy in Jos, North Central Nigeria. STUDY DESIGN: Prospective Cohort Study. METHODS: Participants who met the criteria under GA had dissection Tonsillectomy ± Adenoidectomy between August 1, 2017-July 31, 2019 at the Jos University Teaching Hospital, Nigeria, were enrolled. Data analysis was by SPSS version 21.0 Chicago, IL, USA. RESULTS: We studied 96 participants with a M:F = 1.7:1. Age range was 9months-51years with a Median = 3.0years. Snoring-83(86.5%), Nasal obstruction - 71(74.0%), Mouth breathing -18(18.8), OSA(S) - 17(17.7%) were main features. Seventy-Eight (81.2%) were Grade III & IV and 71(75.0%) had Adenoid Nasopharyngeal Ratio >0.5. Mean INR was 1.22 ± 0.24 where 28(29.2%) were abnormal. Post-operative blood loss was 10ml - 250ml with Median = 35ml. There was a correlations between the Brodsky's grading with Tonsil volume and between Tonsil grade with volume of blood loss. An estimated 76.0% had the surgery within 60mins. We practice 'awake' extubation. Incidence of Primary PTH of 3.1% with no secondary PTH or mortality. CONCLUSION: We established that blood loss was directly proportional to the tonsil size which brings new insights in PTH prevention. Our use of specific agents for GA, technique/ expertise, pillar infiltration with Lignocaine, 'awake extubation, liberal post-operative analgesia with systemic antibiotics may be responsible for the low incidence of PTH in this series.

CONTEXTE: L'hémorragie post-amygdalectomie (HPT) est l'une des complications les plus mortelles et l'une des principales réclamations/convictions pour faute professionnelle dans la pratique de l'oto-laryngologie. OBJECTIF: Étude de la stratégie de réduction des hémorragies pulmonaires à Jos, dans le centre-nord du Nigeria. PLAN DE L'ÉTUDE: Étude de cohorte prospective. MÉTHODES: Les participants qui répondaient aux critères de l'AG ont subi une amygdalectomie ± adénoïdectomie par dissection entre le 1er août 2017 et le 31 juillet 2019 à l'hôpital universitaire de Jos, au Nigeria, ont été inscrits. L'analyse des données a été effectuée par SPSS version 21.0 Chicago, IL, USA. RÉSULTATS: Nous avons étudié 96 participants avec un rapport M:F = 1,7:1. La fourchette d'âge était de 9 mois à 51 ans avec une médiane de 3,0 ans. Le ronflement - 83 (86,5%), l'obstruction nasale - 71 (74,0%), la respiration buccale - 18 (18,8), le SAOS(S) - 17 (17,7%) étaient les principales caractéristiques. Soixante-dix-huit (81,2%) étaient de grade III et IV et 71 (75,0 %) avaient un rapport adénoïdenasopharyngé >0,5. L'INR moyen était de 1,22 ± 0,24 et 28 (29,2%) étaient anormaux. La perte de sang postopératoire était de 10ml -250ml avec une médiane de 35ml. Il y avait une corrélation entre le classement de Brodsky et le volume de l'amygdale et entre le classement de l'amygdale et le volume de la perte de sang. Environ 76,0% des patients ont été opérés dans les 60 minutes. Nous pratiquons l'extubation "éveillée". Incidence de l'HTP primaire de 3,1% sans HTP secondaire ni mortalité. CONCLUSION: Nous avons établi que la perte de sang était directement proportionnelle à la taille de l'amygdale, ce qui apporte de nouvelles perspectives dans la prévention de l'HTP. Notre utilisation d'agents spécifiques pour l'AG, notre technique/expertise, l'infiltration des piliers avec de la lignocaïne, l'extubation éveillée, l'analgésie postopératoire libérale avec des antibiotiques systémiques peuvent être responsables de la faible incidence d'HTP dans cette série. Mots-clés: Dissection de l'amygdalectomie, Perte de sang, Stratégie de réduction, Résultat.

Experience in the management of the mass casualty from the January 2010 Jos Crisis.

BACKGROUND: On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident. OBJECTIVE: To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010. METHODOLOGY: We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010. RESULTS: A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point. CONCLUSION: This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.

Assessment of the sociodemographic characteristics and efficacy of screening for oral, head and neck potential malignant lesions in apparently healthy adults in Jos Nigeria.

BACKGROUND: The efficacy of screening for oral, head and neck cancers (HNCs) in adequately identifying high-risk groups is controversial. OBJECTIVES: This study aims to review our experience with a free oral, HNC-screening program to determine the sociodemographic characteristics of the participants and the effectiveness of this program to improve future programs. MATERIALS AND METHODS: A prospective cross-sectional survey of participants in a free oral, HNC screening exercise was performed in the years 2009, 2012, and 2013. RESULTS: In the years of screening, 135 participants presented aged between 21 and 83 years (mean = 47.0; ±15.6) with a male to female ratio of 1.2:1. 32.6% consumed alcohol, and 17.8% were smokers. Smoking (P = 0.04) and alcohol use (P = 0.05) were associated with higher rates of suspicious malignant symptoms. There was no statistical correlation between symptom prevalence and the number of participants requiring immediate consultation for oral, HNC (r = 0.47), and those referred for routine follow-up (r = 0.34). Premalignant and malignant lesions were diagnosed in 5 males aged 44-72 years. 83.7% found the screening program beneficial in increasing their awareness of the disease. CONCLUSIONS: This hospital-based screening demonstrates improved awareness among people about oral, HNCs, and survival outcomes on a small scale. A community-based screening with health education to target a larger high-risk population is recommended to encourage individuals to modify high-risk factors and improve outcomes.

Incidental maxillary sinus findings on cranial computerized tomographic scan in a tropical setting.

BACKGROUND: Abnormalities in the maxillary sinuses are occasional findings on routine CT scans of the head. AIM: To study the incidental findings in the CT scans of the maxillary sinuses in patients with indications other than sinuses-related diseases. SETTING: Jos University Teaching Hospital, Jos, Nigeria. MATERIALS AND METHODS: Images of patients who underwent CT scan of the head over a 5-month period (January 2015- May 2015) were retrospectively reviewed with the exclusion of those whose indication for the scan was trauma or sinus related disease. RESULTS: A total of 121 CT scan images were reviewed comprising 72 males and 49 females with a male to female ratio of 1.5 to 1.0. Their age range was between 5 and 90 years with a mean of 47.5 ± 20.4 years. The mean age of males was 48.7± 21.2 years while that of females is 45.7± 19.1years. The weight of the patients ranged between 12kg and 109kg with a mean weight of 64.7 ± 16.6kg. The most frequent indications for cranial CT scan were cerebrovascular accident (57; 47.1%), suspected space occupying lesion (23; 19.0%) and persistent headache (5; 4.1%). In all, 93(76.8%) patients had normal scan while 28 (23.2%) patients were observed with sinus pathology. Maxillary mucosal thickening with associated fluid level constituted 11 (9.1%) of the pathologic findings, and this was found bilaterally in 4(3.3%) patients. Seven (5.8%) patients had maxillary mucosal thickening only, with this occurring bilaterally in 4(3.3%) patients and 10 (8.3%) patients had polypoid masses, with bilateral polyps in 1(1.2%) individual. There was no statistical significance with the patient's weight in relation to the sinus findings. CONCLUSION: Incidental maxillary sinus pathologies on cranial CT scan are not infrequent. Vigilance is necessary during routine review and reporting of CT scans of the head for appropriate inclusion and interpretation of these findings towards optimal patient's care.

Role of Fine Needle Aspiration Cytology (FNAC) as a Diagnostic Tool in Paediatric Head and Neck Lymphodenopathy.

A neck mass that is present for longer than a week might be pathological requiring rapid and thorough evaluation. This study aims to evaluate the positive role Fine needle aspiration cytology plays in the diagnosis of pediatric patients with lymphadenopathy in the head and neck region. Fine needle aspiration of lymph nodes was carried out, fixed and stained by cytopathologists for 56 patients at the Jos University Teaching Hospital, 43 (76.8%) were inflammatory and 13 (23.2%) malignant. Reactive hyperplasia (72.1%), acute suppurative (18.6%) and tuberculosis (9.3%) constituted the inflammatory lesions. Non Hodgkins lymphoma was the commonest malignant lesion (76.9%) followed by Hodgkins lymphoma (15.4%), the least being Rhabdomyosarcoma (7.7%). Age range 10-14 years had the highest number of cases (46.4%). Males were 36 (64.3%) while females were 20 (35.7%). All malignant cases diagnosed by FNAC had to undergo confirmation/characterization by histology and had 100% concordance. Thus there were no false positives and specificity was 100%, sensitivity 100%. Of the 43 diagnosed as inflammatory by FNAC, 12 cases which did not resolve after treatment or where patients condition worsened had to undergo surgical biopsy. Out of these only 1 (8.3%) case of fungal infection was misdiagnosed by FNAC. The lymph nodes were generalized 4 (7.1%) and localized in 52 (92.9%). Maximum number of cases 53 (94.6%) had Cervical Lymphadenopathy followed by axillary 2 (3.6%) and inguinal 1 (1.8%). Out of the cervical group of nodes, the upper anterior and upper posterior deep cervical nodes were involved in majority of cases (95%).

SURGICAL MANAGEMENT OF VOCAL CORD PARALYSIS: THE NEED FOR CAREFUL PATIENT SELECTION.

BACKGROUND: Vocal cord paralysis is one of the challenging laryngeal clinical entities confronting the Laryngologist and indeed, the Phono-surgeon. The ability to maintain an effective balance between voice and airway function to ensure good quality of life requires expertise. This study is therefore designed to highlight our experience on surgical management of vocal cord paralysis. METHOD: Clinical notes of all patients that met the inclusion criteria for this study on vocal cord paralysis over a ten-year period were analysed. Data was generated from patients' case files retrieved using standard codes according to the International Classification of Diseases (ICD-10). RESULTS: From the 7,941 new ENT cases seen, 26 patients had vocal cord paralysis (VCP) giving a prevalence of 0.3%. The male to female ratio was 1: 4.2 with a mean age of 45.7years ± 6.3. Their ages ranged from 21-80 years. Thyroidectomy was the main causal factor in 46.2% while idiopathic causes was documented in 23.1%. Twenty-three patients (88.5%) had unilateral VCP from which 21(91.3%) were abductor paralysis. The ratio of Left: Right VCP was 3:1. All the 3 bilateral cases were abductor paralysis. Neurotropic agents only, were effective in cases of unilateral VCP. However, in those with bilateral paralysis, two had tracheostomy only, while the third had a laryngo-fissure, arytenoidoplasty and endo-laryngeal stenting in addition. All were successfully decannulated with good voice quality. CONCLUSION: With these observations, we suggest the choice of appropriate surgical technique, timing and careful patient selection in order to preserve voice, curtail operative sequelae and achieve good quality of life (QoL) which is the overall management strategy, be borne in mind.

Bacterial isolates in chronic suppurative otitis media: a changing pattern?

The most frequently isolated organism in chronic suppurative otitis media from different parts of the world is Pseudomonas aeruginosa. The pattern from this bacteriological study from our region is different. This study was carried out on 97 patients presenting to the outpatient clinic of the National Ear Care Center, Kaduna. Nigeria from May 2008 to April 2009. The patients were aged between 1 year and 75 years comprising 50) males and 47 females giving a male to female ratio of 1:1. Most of the patients (n=40, 41.2%) were in the age group 1-10) years. Seventy-five (77.3%) patients had a positive culture while in 22 (22.7%) patients there was no growth. Gram-negative bacteria comprised 80% of the isolates. The predominant organisms cultured were Klebsiella sp (n=31, 41.3%), Escherichia coli (n=22, 29.3%) and Pseudomonas aeruginosa (n=6, 8%). The gram-positive isolates were Streptococcus sp (n=8, 10.8%) and Staphylococcus aureus (n=7, 9.3%). In-vitro drug sensitivity pattern of all isolates shows that they were more sensitive to Ofloxacin, ciprofloxacin and Perfloxacin. Klebsiella sp. Escherichia coli and Streptococcus sp. are the leading pathogenic organisms in chronic suppurative otitis media in our region and their ensitivity rates are highest to the quinolone antibiotics, which are relatively cheap, readily available as ototopic agents and lack ototoxic effects.

Clinicopathological profile of malignant tumors of the oropharynx: a case series.

BACKGROUND: Due to recent lifestyle changes, the worldwide incidence of malignant oropharyngeal tumors is on the increase. This study focuses on the clinical and pathological profile of malignant tumors of the oropharynx as seen in a north-central Nigerian teaching hospital. METHODS: This is a descriptive retrospective analysis of the clinical and pathological profile of this disease. RESULTS: Six patients aged between 37 years and 78 years had malignant oropharyngeal tumors. There were 5 (83.3%) males and 1 (16.7%) female. All patients presented with cervical swelling, dysphagia, odynophagia and muffled voice with dental caries and visible masses filling up the oral cavity and oropharynx. Four (66.7%) patients presented with dyspnea and 3 (50%) with otalgia and deafness. Three (50%) patients had histologic diagnosis of non-Hodgkin's lymphoma (centroblastic), 1 had lymphoepithelioma and 2 had squamous cell carcinoma. Two (33.3%) patients died during treatment, 2 (33.30%) defaulted and 1 (16.7%) is being followed up for 5 years and is tumor free. CONCLUSION: Oropharyngeal cancer has a poor prognosis in the tropics due to late presentation. Proper health education aimed at early detection and treatment in our environment is required.

Experience with rigid esophagoscopy in Jos, north-central Nigeria.

OBJECTIVE: Esophagoscopy which may be done for either a therapeutic or diagnostic reason has remained useful in the management of esophageal diseases. This study evaluates our experience with rigid esophagoscopy with special emphasis on esophageal foreign bodies in our unit. METHOD: This is a six-year (January 2000-December 2005) retrospective review of cases of rigid esophagoscopy in the Ear, Nose and Throat Unit of our center. RESULTS: Fifty-seven patients with ages ranging from 10 months 75 years were studied. There were 35 (61.4%) males and 22 (38.6%) females. Fifty-three of the patients (93%) had varying foreign bodies in the esophagus, 3 (5.2%) patients had carcinoma of the esophagus while 1 (1.8%) had pharyngeal pouch. The 0-10 year age group had the highest prevalence of esophageal foreign bodies (66.0%) with the middle third of the esophagus been the commonest site of impaction (58.5%). There was no fatality recorded. CONCLUSION: Rigid esophagoscopy is a relatively safe procedure in trained hands and ideal environment with the necessary facilities in place.

An unusual oronasal foreign body: report of a case.

BACKGROUND: Foreign body removal in children is very common in the daily routine of an otolaryngologist but reports of oronasal foreign bodies and their management are rare. METHOD: The case note of a 5-year-old female child presenting with an oronasal foreign body following a domestic accident was retrieved and studied and followed up. RESULT: a 5-year-old female child with an oronasal foreign body which created an oronasal fistula that was closed with local palatal mucoperiosteal-lined flaps. The patient defaulted following treatment, a common practice by patients in our society. CONCLUSION: This report highlights the occurrence of this rare condition, its management and the need to put measures in place to prevent domestic accidents especially for those most at risk.

Tinnitus and the prevalence of co-morbid psychological stress.

BACKGROUND: Tinnitus is a symptom of unknown pathophysiology with few therapeutic measures and may present with co-morbid psychological stresses necessitating psychiatric treatment. This study aims at determining the prevalence of depression and anxiety in tinnitus sufferers in our environment. METHOD: This is a one year (April 2006 March 2007) prospective study of out-patients presenting with tinnitus to our Ear, Nose and Throat clinic who were administered the Hospital Anxiety and Depression Scale (HADS) questionnaire until the sample size was reached. RESULTS: Questionnaires were administered to one hundred and four patients with tinnitus, 92 patients filled theirs correctly and these were analyzed. There were 42 (45.7%) males and 50 (54.3%) females (Table 1) with an age range of 20 to 78 years. Six hundred and eighty seven patients presented with various otologic ailments in the study period, of which 104 (15.1%) patients had tinnitus. The overall prevalence of depression was 17.4%, higher in females (9.8%) than males (7.6%). The overall prevalence of anxiety was 22.8% with males having a higher prevalence (11.9%) than females (10.9%). Three (3.2) patients had both depression and anxiety Eighty three (90.2%) patients were in the active and productive age group with 13 patients (prevalence of 14.1%) having depression and 20 patients (prevalence of 21.7%) with anxiety. CONCLUSION: We recommend the screening or assessment for psychological distress in tinnitus sufferers so that patients can be adequately treated.

An unusual rhino-pharyngeal foreign body.

BACKGROUND: Foreign bodies of the upper aerodigestive tract are commonly seen in the paediatric population; however adult patients with nasal foreign bodies in particular are much less common and when sharp foreign bodies are present there is a great risk of developing complications. STUDY DESIGN: This is a case report of a 20-year-old male magician with impacted rhino-pharyngeal foreign body. He intentionally inserted two long sewing needles into the right nasal cavity during a magical act. RESULTS: The impacted foreign bodies were located in his nose/pharynx and removal was achieved per orally under general anaesthesia. Only a minimal evidence of retropharyngeal abscess was noted despite the prolonged stay of the foreign bodies. CONCLUSION: This case highlights the fact that both a deliberate and an accidental foreign body in an adult nasal cavity can get impacted as well as the significance for its early removal.

Hypopharyngeal paraganglioma: a case report.

Paragangliomas are neuroendocrine neoplasms that primarily afflict patients during the fourth and fifth decades of life. The majority of extra-adrenal paragangliomas arise in the head and neck region, notably from the carotid and aortic bodies, jugular bulb and tympanic plexus. Although one-fifth of all parapharyngeal neoplasms are paragangliomas, primary hypopharyngeal paraganglioma is relatively uncommon, only one other case having previously been documented by Filippin et al. (1989). We report a second case of hypopharyngeal paraganglioma in an 18-year-old male as seen in our center.